Neal Lesh

Computer science applications to improve health delivery in low-income countries.

My Story

Mid-thirties computer researcher seeks more fulfilling career. Goes back to school then off to Africa. Discovers things are more simple and more complex than he originally imagined. Can't imagine doing anything else...

Thesis

It is increasingly possible to

apply computer innovation to

improve health care delivery in

low-income countries.

Who are you?

It is increasingly possible to

apply computer innovation to

improve health care delivery in

low-income countries.

What’s in this for you?

• Taste of global health• Confidence that information can help• Two examples

Patient record systems for AIDS treatmentMedical algorithms on handhelds

• Cautionary cartoon

Global Health Puzzle

Canada MexicoDeaths per 1000 per year (2003 est.) 7.61 4.97

Is Mexico healthier than Canada?

Older populations are less healthy!

Risk Factorfor surviving the Titanic.

0

10

20

30

40

50

60

70

1st 2nd 3rd

class of service

% s

urvi

ved

Poverty as a

Global Health

Simple Story$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$

$

Infant mortality: 5 per 1,000 births

Maternal mortality: 8 per 100K births

Life expectancy: 78 years

Infant mortality: 95 per 1,000 births

Maternal mortality: 500-1000 per 100K

Life expectancy: 45 years

Simple Story$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$

$$$$

Simple Story

“We are the first generation that can end poverty.”

-Eveline Herfkens, UN Millennium Campaign

Complexity• Corruption, careerism, tax write-offs• 5-star poverty alleviation meetings• Unintended consequences, e.g., paying volunteers• Imperialism & foreign experts

“If you want to build a ship, don't drum up people to collect wood and don't assign them tasks and work, but rather teach them to long for the endless immensity of the sea.”– Antoine de Saint-Exupery

Information as Care

• Study: rigorous application of standard treatment protocols reduced in-hospital mortality in children’s malaria cases by 50%

• Clinician’s complaint: where are my lab results?!

• Patient Knowledge Example: five danger signs for seeking care during and after labor.

Roadmap

• Taste of global health• Confidence that information can help• Two examples

Patient record systems for AIDS treatmentMedical algorithms on handhelds

• Cautionary cartoon

One year later

AIDS Treatment in Rural Rwanda

One year later

Improving Health Systems

One year later

Infrastructure

Electronic Medical Record (EMR)

Patient MonitoringReports

Clinicians & Patients

Managers

EMR Staff

Paper forms

Program MonitoringReports

Funder & governmentreports

$

Re-allocate resources

Patient Monitoring

Unsuccessful Report

Successful Report

Unsuccessful Report

OpenMRS

• Open source framework for medical record systems

• www.openmrs.org

Data Quality

• Mistyped IDs• Missing &

conflicting data• Backlog

Potential solution: point-of-care systems

Roadmap

• Taste of global health• Confidence that information can help• Two examples

Patient record systems for AIDS treatmentMedical algorithms on handhelds

• Cautionary cartoon

Rural Dispensary in Tanzania

Standardized Care (IMCI)

Standardized Care (IMCI)

Standardized Care (IMCI)

10

15

20

25

30

35

1999-00 2001-02

An

nu

al

mo

rta

lity

ra

te

Morogoro (IMCI) Rufiji (IMCI)

Ulanga Kilombero

Tanzania: underfive mortality was 13% lower in the two IMCI districts

Source: Schellenberg J et al

Full IMCIin HF

End ofstudy

13% difference95% CI: -7%, 30%

Significant impact on stunting

Deploying IMCI

• IMCI – Shown to reduce mortality and morbidity– Adopted by ~100 countries

• But uptake not as good as hoped– Training expensive– Correct use tapers off over time– Supervision challenging

How Automate IMCI?

Why Automate IMCI?

Why Automate IMCI?

• Improve adherence• Improve

supervision• Easier to update• More sophisticated

protocols• Reduced training

Field Work

Results to be published in CHI’08

Viral Training

Adherence ResultsInvestigation

Current practice adherence

e-IMCI adherence

p-value

Vomiting 66.7% (n=24) 85.7% (n=28) -

Chest indrawing 75% (n=20) 94.4% (n=18) -

Blood in stool 71.4% (n=7) 100% (n=3) -

Measles in the last 3 months

55.6% (n=9) 95.2% (n=21) < 0.05

Tender ear 0% (n=1) 100% (n=5) -

All 61% (n=299) 84.7% (n=359) < 0.01

What are we going to do today, Brain?

The same thing we do every day, Pinky….

Make a plan to TAKE OVER THE

WORLD!!!!!

Thank you!neal@equalarea.com